How do the CQC’s Key Lines of Enquiry impact your healthcare service?

Organisations in the health and social care sector are responsible for providing the service that their patients, residents, staff and any others they care for require. The Care Quality Commission (CQC) is an independent regulator within the industry which keeps these organisations accountable by monitoring, inspecting and regulating them according to their own set of fundamental standards. The CQC’s inspection teams use key lines of enquiry (KLOEs) and prompts to assess these healthcare services, so this article explores what these KLOEs are and why they are important for you as a health or social care provider.

When carrying out an inspection of a healthcare organisation or service, the CQC adopt their KLOEs and prompts to answer five key questions - is the service safe, effective, caring, responsive and well-led? From these, the inspectors provide the following ratings, for each key line of enquiry, depending on how your organisation performs: Outstanding; Good; Requires improvement; or Inadequate.

Safe?

A safe organisation or service is one that protects people from abuse (physical, sexual, mental or psychological, financial, neglect, institutional or discriminatory abuse) and avoidable harm. Whether your organisation provides a safe service is what the CQC inspection team initially seek to determine with their first 6 key lines of enquiry.

The following CQC KLOEs identify whether your organisation provides a safe service:

• (S1) Safeguarding. Have you implemented safeguarding practices that protect those in your care or employ from abuse?
• (S2) Managing risks. How does your organisation assess risks and are these monitored and managed to keep patients and staff safe?
• (S3) Safe care and treatment. Do staff have all the necessary information to provide safe treatment and care?
• (S4) Medicines management. What measures do providers have in place to ensure the safe and proper use of medicines?
• (S5) Track record. An assessment is made of an organisation's past and current safety practices.
• (S6) Improving on past errors. Has your organisation shown an ability to learn from mistakes and make improvements to prevent them from occurring again?

Effective?

Further to questions of an organisation's safety practices, the CQC establish the effectiveness of its service, whether the care, treatment and support provided results in positive outcomes, and that this is based on the best available evidence, helping to promote a good quality of life.

So, what makes an organisation or service effective?

• (E1) Needs assessment and evidence-based treatment. Are people's needs assessed and is care and treatment delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes?
• (E2) Monitoring outcomes and comparing with similar services. Does your organisation routinely collect the information resulting from the care and treatment of people and monitor whether this information demonstrates that the intended outcomes are achieved? How do these results compare with similar services performed?
• (E3) Staff skills and knowledge. This KLOE concerns (a) whether people in the care of your organisation or service are having their assessed needs, preferences or choices met with the correct skills and knowledge by staff; (b) whether your staff have been provided with sufficient and appropriate training and enough protected time to carry out this training; and (c) how your staff are supported (for instance, appraisals, mentoring or one-to-one meetings) in order to evaluate staff performance.
• (E4) Teamwork amongst staff, teams and services. This regards the inclusion practices of your organisation to ensure that all necessary staff are involved in the assessment, planning and delivery of care and treatment, how the care is delivered and reviewed effectively when coordinating between different teams, services or organisations, and whether all necessary staff are kept informed when people are discharged from a service.
• (E5) Support towards living healthier lives. How does your service or organisation provide the right tools or plan for those in your care or employ to monitor their health and empower and support them to manage their own health?
• (E6) Correct procedure for consent to care and treat people. How does your organisation ensure that the relevant requirements of legislation and guidance are understood and followed by staff?

Caring?

When working in the care sector, ultimately you have to treat people with kindness, compassion, dignity and respect. The CQC evaluate how caring organisations and services are according to three key lines of enquiry.

• (C1) Kindness, respect and compassion. What practices does your organisation have in place to ensure staff treat people who use the service with respect, depending on their personal, cultural, social or religious needs, and appropriate support?
• (C2) Involving people in care in decisions about their care. This KLOE is to show the CQC that your organisation provides the right service to support people in being actively involved in decisions made about the care, treatment and support they receive. Therefore, how do staff involve people in care in these decisions?
• (C3) Privacy and dignity. How does your organisation respect and promote people's privacy and dignity? This includes making sure that staff respond to people's physical pain, discomfort or emotional distress in a compassionate and appropriate manner.

Responsive?

People's conditions and needs differ from person to person and can change with one person on a daily basis. How services are organised to respond to these changes is, therefore, another key factor in how the CQC rates an organisation.

• (R1) Person-centred care. This key line of enquiry is to establish whether an organisation's service reflects the needs of those in its care or employ and that the appropriate practices, facilities and premises are provided to deliver these services.
• (R2) Accounting for the needs of different people. Providing services that are accessible to the needs of different people is important in establishing the responsiveness of your organisation. This refers to the way in which people are treated through the whole process within which they deal with your organisation, from referral and transfer between services, to discharge.
• (R3) Timely access to care and treatment. An organisation is rated according to the timeliness of their service, from people with the most urgent needs having their care and treatment prioritised, to the time in which test results, diagnosis and treatment can be accessed.
• (R4) Concerns and complaints. How does your organisation ensure that concerns and complaints are considered and used to improve the quality of care provided?

Well-led?

Is your organisation led, managed and governed to assure the high-quality and person-centred care is delivered, as well as to promote learning and innovation within an open, fair culture? This is the final area that the CQC inspects an organisation or service.

• (W1) Leadership capacity and capability. Are your leaders armed with the right knowledge, skills, integrity and experience needed to deliver high-quality, sustainable care, and are these leaders visible and approachable?
• (W2) Vision and strategy. This KLOE investigates whether an organisation has a clear vision and robust strategy in place to prioritise the delivery of quality and sustainable care.
• (W3) The organisation's culture. An organisation should be led by a culture that prioritises high-quality, sustainable care. This places focus on the treatment staff receive, for instance, does the organisation place emphasis on the safety and wellbeing of its staff? Are the relationships among staff cooperative, appreciative and supportive?
• (W4) Governance and management. With this key line of enquiry, the CQC aim to establish if an organisation has established clarity around the responsibilities, roles and systems of accountability in order to promote good governance and management.
• (W5) Performance and risk management. What processes does your organisation have in place to review and improve current and future performance, and to take into account possible risks?
• (W6) Information management. An organisation should implement effective processes and technology in order to obtain accurate and appropriate information.
• (W7) Engagement and involvement. A well-led organisation will successfully engage and involve all stakeholders who use their services - staff, external partners and the public - to promote a high-quality, sustainable care service.
• (W8) Learning, improvement and innovation. Continuous learning, improvement and innovation play an important role in all well-led organisations. Does your organisation effectively review the performance of staff and systems to establish areas of need for learning and improvement?

This article demonstrates how the CQC uses key lines of enquiry to assess whether an organisation is safe, effective, caring, responsive and well-led. Using these, and the full list of KLOEs on the CQC website, you can identify your organisation's strengths and areas for improvement. Our Health and Social Care industry page offers all you need to upgrade your service quality and staff's skills with convenient and cost-effective online training courses. Take charge of your training today.